Maya Midwifery Expands Service With Mobile Clinics

Twins at the end of a bumpy road!

I was lifted clear off of my seat as our Land Cruiser bounced down the winding mountain road en route to Toj Rincón, the site of one of our mobile clinics. The air was cool in the early morning, with some lingering clouds hovering in the valley below. Fields, brown with hummocks of fresh earth waiting for potato seed, lay in patchwork quilts all around us. Most seemed impossibly steep to plant, yet there were men shouldering picks and burlap sacks disappearing on small trails winding up and down to their fields.

Our entourage included three Mayan midwives, Fabiola, Griselda and Nancy; the driver, Ruben; our Guatemalan doctor, Valeria; and myself. Sitting sideways on the bench in the very back, I clutched the small carry-on suitcase that contained our portable ultrasound machine. It is a rather fragile tool in contrast to the sturdy implements carried by the farmers. As we rode toward the village, we hoped our lashings were tight enough around our large plastic boxes that were carrying our medical supplies on top of the Land Cruiser. Next to the boxes, we had used large pieces of black plastic to tie down a mattress, cot and massage table to be used as a consult beds. This was only a thin defense against the clouds of fine dust that were raised while traveling on the back roads during the dry season.

After another hour or so of ruts and bumps, the village slowly came into view. There was a collection of brightly painted concrete houses, interspersed with more humble structures of corrugated tin and crude wooden planks. Uniformed school children dotted the road, holding hands and darting off to the side as we passed. The road wound down through the center of town, then ascended again as we rose above the village once more. When we realized that we missed our destination, we had to turn around. “Behind the red painted store,” described Doña Margarita, Toj Rincón’s village midwife. It was difficult to see this very squat structure nearly hidden from our view on the downhill side of the road.

Ana's firstborn child waits patiently during her mother's appointment at the mobile clinic.

Doña Margarita was generously loaning us her entire house. The home was complete with two beds in a large bedroom, which we divided into two consult rooms using a sheet. In between the beds, we found a perfect table for the ultrasound machine. The main room of the house provided a place for ‘the pharmacy’ and a registration table.

Dark-eyed children, not yet in school, shyly hid between their mothers’ hand-loomed skirts as a small crowd of women slowly gathered on tiny wooden benches just outside the house. Doña Margarita had indeed fulfilled her promise to help publicize our first mobile clinic in Toj Rincón.

Inside the house, Fabiola was attending to Ana, pregnant. Ana appeared to be measuring further along than her last period would have suggested. Together, Fabiola and Valeria used the ultrasound, plumbing the depths of the belly with sound. Soon, they were able to reveal the source of the confusion: twins! This news took both Ana and Doña Margarita by surprise. Ana appeared to be healthy, and was found to be about four months along in the pregnancy.

Dr. Valeria shares the discovery of twins with Ana, a pregnant mother in Toj Rincón.

In this mountainous village, birthing twins can present a bit of a dilemma since it is about two hours from the nearest hospital in Quetzaltenango (Xela). This mother was planning on having a home birth because this was her second pregnancy. Concerned, with a quick cell phone call, we set up a referral for her to have a more formal ultrasound and consult with an OB-GYN physician stationed two hours away in Xela. The doctor has agreed to see any of our referrals at a much-reduced cost.

The only hard part now is getting her to actually go to Xela. Not only do we need to convince Ana that this appointment is important enough for her to take time away from home duties, but arranging transportation is also difficult. This situation is such a contrast to what we see in the United States, where we tend to take specialty care and referrals for twin pregnancies for granted. Instead of worrying about making the appointment, many women in the United States can look ahead and focus on the challenges of diapering and raising twins. Despite this worry, Ana’s ultrasound was a moment to savor as the midwives raptly looked at the images of the twins and the mother’s reaction to the news.

Fabiola, a Mayan midwife, takes Ana's patient history in Toj Rincón.

It was astounding to watch all of the logistics come together in this small mountain village: the planning, fundraising, ultrasound training, networking with local providers, procuring supplies and medication, hiring and scheduling. The reason we got up so early and bounced along in the Land Cruiser on those crazy roads was to find a mother with a challenging pregnancy, and refer her to expert care. It is also why I cannot wait to return next month to see how Ana and her twins are doing. This is what the mobile clinics project is all about.